2024.11.02

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Introduction: This marks the first time since the initiation of the national negotiation six years ago that the National Healthcare Security Administration has disclosed the status of the negotiation to the public after the conclusion of the on-site negotiations but before the formal announcement of the catalog adjustment results.

The new version of the medical insurance drug catalog is expected to be released at the end of the month and will officially take effect from the beginning of next year. The National Healthcare Security Administration recently announced the latest progress of the on-site negotiation work for the adjustment of the national medical insurance drug catalog in 2023. The overall results this year are basically consistent with previous years, characterized by faster access for new drugs, no distinction between domestic and foreign investments, and prices matching clinical value.

This marks the first time since the initiation of the national drug price negotiations six years ago that the National Healthcare Security Administration has disclosed the details of the negotiations immediately after their conclusion, prior to the formal announcement of the catalog adjustment results. This also indicates that the adjustment of China's medical insurance drug catalog has entered a dynamic, normalized, and standardized track.

From [date] to [date] noon, the National Healthcare Security Administration organized 100 negotiation experts from medical insurance departments across various provinces nationwide to conduct on-site negotiations and bidding with relevant pharmaceutical companies. This involved 100 companies and 100 drugs, including 100 drugs not on the medical insurance list and 100 drugs on the medical insurance list for continued negotiation and renewal.

Reviewing the past few years of medical insurance negotiations, the cycle has become increasingly stable, work efficiency has improved, and the speed of new drug access has accelerated. The adjustment cycle of the catalog has been shortened from the previous maximum of years to years, the number of varieties participating in negotiations each year has expanded from the previous years' varieties to over varieties in the past two years, and around % of new drugs can be included in the medical insurance catalog within two years of their market launch.

The relevant official from the Department of Medical Services Management of the National Healthcare Security Administration stated that the national medical insurance negotiations have demonstrated the governance advantages of the healthcare security department in system integration. In recent years, the sales of newly added drugs under the agreement during the medical insurance negotiations have reached nearly 10 billion yuan, with medical insurance fund expenditures exceeding 10 billion yuan. Such a large amount of funds has mainly been optimized and adjusted within the original expenditure structure, without significantly increasing the financial burden on the public.

The specific manifestations are as follows: Firstly, a preliminary mechanism for the price adjustment of negotiation drugs throughout their lifecycle has been established, guiding the prices of protocol-period products to be more fair and reasonable through simplified renewal and re-negotiation. Secondly, by promoting high-quality generic drug substitution through centralized procurement, space is created to support innovative drugs. Preliminary estimates indicate that the centralized volume-based procurement of drugs and medical consumables implemented by the state in recent years has created nearly 100 million yuan in medical insurance fund space for the access of new drugs, new technologies, and adjustments in medical service prices. Thirdly, payment management has been strengthened. Through measures such as enhanced supervision and payment method reforms, efforts are made to ensure that "every cent is spent on the cutting edge," significantly improving the necessity, standardization, and rationality of drug expenditure.

First Financial News reporters learned at the national negotiation site that "tension, intensity, and stalemate" are the characteristics of this year's national negotiation. The multi-party calculations by the medical insurance in the early stages, the game between the corporate side and the medical insurance side on the negotiation table, are all aimed at finding a reasonable price for the drugs.

Industry insiders told the First Financial Daily reporter that the annual national negotiation has established a scientific guidance mechanism to find a reasonable price for valuable drugs. The price is not necessarily lower the better, but should achieve a match between price and value. Under the premise of ensuring basic needs, it aims to improve the level of drug security for the public, while also supporting and encouraging innovation in enterprises.

The above-mentioned official stated that the medical insurance negotiation has always adhered to the principles of doing one's best and acting within one's means, not making excessive promises or raising unrealistic expectations. The goal is to balance the diverse needs of insured individuals, the clinical use of medicines by medical staff, and the development and innovation needs of the pharmaceutical industry within the limited financial capacity of the fund. The National Healthcare Security Administration has established a series of standardized procedures from catalog application and evaluation to calculation and negotiation, ensuring that the medicines included in the catalog meet basic coverage needs and that their prices are commensurate with their clinical value.

This year, the companies participating in the negotiations include both foreign enterprises such as Novartis and Sanofi, and domestic enterprises like Hengrui and Innovent. There are large multinational corporations like Roche and Johnson & Johnson, as well as emerging biopharmaceutical companies such as Kangfang and Everest Medicines. Additionally, there are state-owned enterprises like China Resources, and private enterprises like Qilu and Yangtze River Pharmaceutical Group.

"The medical insurance negotiation does not distinguish between domestic and foreign capital, enterprise size, or ownership attributes; all qualified drugs are free to apply on their own. The National Healthcare Security Administration welcomes the active participation of pharmaceutical companies in the medical insurance negotiation," the above-mentioned official said.

To achieve the goal of ensuring that insured individuals can buy, use, and get reimbursement for the drugs they need, the national medical insurance drug directory adjustment plan places greater emphasis on the guaranteed supply of drugs. This year, the agreement text has specifically added clauses on ensuring drug supply and incorporated them into assessment management, urging pharmaceutical companies to ensure market supply after their drugs are included in the medical insurance directory through negotiations.

The above-mentioned official stated that for drugs included in the catalog, the focus is on ensuring their implementation and improving accessibility to medication. Local medical insurance departments are promoting hospitals to promptly convene pharmaceutical affairs meetings, reasonably equipping with drugs, and generally establishing a "dual-channel" supply mechanism, allowing drugs that cannot enter hospitals temporarily to be available in pharmacies first, with medical insurance also covering the costs.